| NPI | 1962684563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1505039) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 44465) |
| 101YP2500X Counselor, Professional (Licence: CA LPCC 388) | |
| 106H00000X Marriage & Family Therapist (Licence: AR M1501003) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 2013015040) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2015-05-12 |